Not All Filler Dissolvers Are Equal: Comparing Hyaluronidase Types

A 2025 laboratory study compared how well two kinds of hyaluronidase, the enzyme used to dissolve hyaluronic acid filler, broke down eight different fillers in a dish. The two enzyme types performed similarly, but the fillers themselves varied a great deal: some dissolved quickly at modest doses, while firmer, more cross-linked products needed much higher doses or did not break down within an hour. For patients, the main lesson is that dissolving filler is not one-size-fits-all.

Why this was studied

One of the main safety advantages of hyaluronic acid filler is that it can be dissolved. Hyaluronidase is used to correct filler that has moved, looks lumpy or overdone, or, most importantly, is blocking a blood vessel. In that emergency, the goal is to dissolve product quickly to restore blood flow. Our article on dissolving filler explains when and how it is used.

Two main kinds of hyaluronidase are used around the world. One is purified from sheep tissue (ovine). The other is made in the laboratory to match the human enzyme (recombinant human). Availability varies by country. Clinicians have long wondered whether one works better, and how much is needed for different fillers.

What the researchers did

This was a benchtop study, meaning it was done entirely in a laboratory, not in people or animals. The team placed small, equal amounts of eight commercially available hyaluronic acid fillers in dishes. They added enzyme at several doses and in different amounts of liquid, and left the filler unstirred to roughly mimic conditions in tissue. Saline-only dishes served as controls.

Three surgeons reviewed photographs and microscope images over the first hour and recorded whether each filler had partly or completely broken down. They agreed with each other on every rating.

What they found

Several clear patterns emerged:

• Both enzyme types worked similarly at the doses where they could be compared directly.
• Liquid mattered. When enzyme was added in only an equal volume of liquid, none of the fillers dissolved, even at the highest standard dose. More dilute mixtures worked better, though going beyond three parts liquid to one part filler gave no added benefit.
• Fillers differed widely. Two products broke down within about 40 minutes at moderate doses. The other fillers, which tend to be firmer gels designed for deeper structural support, did not dissolve within an hour at those doses.
• Higher doses helped. When the dose of the sheep-derived enzyme was raised substantially, the more resistant fillers broke down, mostly within 40 to 60 minutes.

How strong is this evidence?

Laboratory studies like this are useful because they allow fair, side-by-side comparisons under identical conditions. But a dish is not a face. The authors point out several limits:

• Living tissue has blood flow, natural enzymes and spreading that a dish cannot reproduce. Enzyme injected into the skin may also keep working for longer than the one-hour window tested.
• Breakdown was judged visually, which involves some subjectivity even with several reviewers.
• Only the sheep-derived enzyme was tested at the highest doses, so the two types could not be compared at those levels.
• Several authors have consulting relationships with filler manufacturers, although they report no funding for this study.

The results cannot give exact doses for real patients. They do support the idea that the type of filler, the amount of liquid, and the dose all influence how quickly hyaluronidase works.

What it means for you

If you have hyaluronic acid filler, it helps to know what product was used and where. Keep a record from each treatment, or ask your clinic to note it in your chart. If you ever need filler dissolved, especially elsewhere or in an emergency, that information can help the treating clinician plan.

It also explains why dissolving can sometimes take more than one session. Firmer fillers used in the cheeks, chin or jawline may resist breakdown more than softer products used in the lips or fine lines. That is not a sign that something has gone wrong.

Hyaluronidase itself is generally well tolerated, but it is a medical treatment with its own risks, including swelling, bruising and, rarely, allergic reactions. People with a known allergy to bee or wasp stings may be at higher risk, and some clinicians perform a skin test first. It should only be given by a trained medical professional. Never use products sold online as "filler dissolvers".

Vascular occlusion, where filler blocks a blood vessel, is rare but needs immediate treatment. Warning signs include sudden severe pain, skin that turns white, grey, blotchy or purple, and any change in vision. Physician-led clinics keep hyaluronidase on hand and follow emergency protocols. Our article on vascular occlusion safety explains these signs in detail.

Questions to ask at your consultation

• Which filler are you using, and can you write down the product and area for my records?
• If I needed it dissolved, how easily would this product break down?
• Do you keep hyaluronidase on site, and what is your emergency plan?
• Do I need a skin test before dissolving, given my allergy history?

Frequently asked questions

Does dissolving filler work immediately?

Some softer products begin to break down within minutes to hours, while swelling from the injection may hide the result for a day or two. Firmer fillers may need more than one session.

Will hyaluronidase dissolve my own natural hyaluronic acid?

It can temporarily affect the body's natural hyaluronic acid in the treated area, but the skin replaces its own supply quickly. Any temporary hollowing usually settles.

Is one type of hyaluronidase safer?

This study looked at how well each type broke down filler, not at safety in people. Choice of enzyme depends on what is authorized and available and on each patient's history.

Knowing that filler can be dissolved, and that the process varies, is part of making an informed choice. If you would like to talk about your filler history or how reversal works, HealthPark Medical Aesthetics can go over it with you at a consultation.

Source

Safran T, Khalaf R, Metelitsa A, Woodward J, Nikolis A. Comparison of the degradability of hyaluronic acid by ovine and recombinant human hyaluronidase. Aesthetic Surgery Journal, 2025. Read the study